Mild Behavioral Impairment May Be an Early Sign of Alzheimer’s

Most people think of memory loss when they think of Alzheimer’s disease. But a proposed new diagnostic tool uses a checklist of behavioral problems that may identify the earliest stages of Alzheimer’s. Such symptoms may be evident even before memory problems become obvious to loved ones and family members.

The checklist looks at a range of personality and behavioral issues related to five main areas: apathy and motivation; mood; impulse control and agitation; social appropriateness; and thoughts and perceptions. Exhibiting changes in any of these fields for at least six months may be an early warning sign of what the researchers refer to as “mild behavioral impairment.”

Among the questions included on the checklist:

*Has the person lost interest in friends, family, or home activities?
*Is he/she less likely to initiate or maintain conversation?
*Does the person view herself/himself as a burden to family?
*Has the person become more anxious or worried about things that are routine (e.g., events, visits, etc.)?
*Has the person become agitated, aggressive, irritable, or temperamental?
*Has she/he become unreasonably or characteristically argumentative?
*Has the person become more impulsive, seeming to act without considering things?
*Is there a change in eating behaviors?
*Does the person hoard objects when she/he did not do so before?
*Has the person developed suspiciousness about the intentions of motives of other people?
*Does the person now talk to strangers as if familiar, or intrude on their activities?

Answering “yes” to these questions or exhibiting other changes in behavior or personality for at least six months, the researchers say, may be an early indication of Alzheimer’s disease. The more changes in behavior, and the greater the severity, the more likely there may be a problem. People in the early stages of Alzheimer’s who have emotional or mood disturbances may, of course, also exhibit problems with memory and thinking.

It is important to note that other diseases and disorders can also explain some of these behavioral changes. For example, major depressive disorder can also be the underlying cause of the first half of the symptoms listed. Some of these symptoms can also be the manifestation of old age. Therefore, it is important to consult a doctor to get a professional assessment.

The name mild behavioral impairment evokes a more widely known diagnosis established more than a decade ago: mild cognitive impairment. People with mild cognitive impairment can go about day-to-day tasks but have memory and thinking impairments, and some go on to develop full-blown Alzheimer’s disease while others don’t.

“Alzheimer’s is a deadly brain disease, and while memory loss is a hallmark of the disease, early symptoms such as anxiety, confusion and disorientation are often more common, troubling and obvious to family members,” said Maria C. Carrillo, the chief science officer of the Alzheimer’s Association. The findings were presented at the association’s international conference in Toronto.

Such behavior changes are common in those in the more advanced stages of Alzheimer’s as well. Common mood and behavioral problems in those with Alzheimer’s include depression and anxiety; wandering or “sundowning,” or becoming agitated as day turns to night; resisting daily care or refusing to eat, drink or take medications; becoming physically or verbally aggressive or disruptive; asking questions repeatedly; having sleep disturbances; rummaging through the house or hoarding things; or withdrawing socially.

In summary, it’s important that those exhibiting such behavior changes be evaluated by a doctor or mental health professional. Depression and other treatable conditions such as vitamin B deficiency can cause similar symptoms and should be ruled out. Many of these and other symptoms can be eased with medications and other treatments.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.